America’s healthcare landscape has begun to look very different compared to that of 10 years ago. The shift towards a single-payer system has begun. Healthcare coverage has been expanded, mandated and subsidized. Hospital networks and mergers have consumed smaller private practices or clinics. Big Data is slowly taking the steps towards implementation. Yet, consumers are still unaware of the true costs to accessing and obtaining healthcare here in the US.
Why? The regulations governing healthcare price transparency still remain unchanged and ineffective. A recent report published by the Catalyst for Payment Reform in conjunction with the Health Care Incentives Improvement Institute, has for the last two years shown no progression or a decline in state efforts to improve price transparency available to consumers. The annual report, title Report Card on State Price Transparency Laws, evaluates each states price transparency initiatives and how readily consumers can access information on statewide healthcare prices. To see the methodology of coming to the reports findings, click here.
Last years report was conducted with little expectation of any positive findings. Researchers found that 72% of the nation had failed to improve on the information they provided consumers on the actual costs on medical treatments and procedures. In fact only 14 states nationwide were given a 'C' grade or better by the research team, with only 2 states achieving 'A' grades.
This years report was expected to show improved efforts by states and statewide providers – except researchers found even more regression. The lack of improvement however, has been accredited to the widening of the reports’ scopes and its increasing of factors affecting a states grading.
The number of failing states actually increased from 29 to 45 throughout the year, with no states receiving an 'A' grade. How? Researchers factored in many new aspects of reporting healthcare price transparency, including the requirement of a mandated or volunteer website providing consumers access to such information and the utilization of an All-Payer Claims Database (APCD). Researchers also removed the grading curve from their methodology, putting more focus on individual state efforts.
These efforts towards price transparency are even more valuable now than ever before with millions of Americans paying more of a significant percentage of their health care costs without the ability to comparison shop. As consumers of a product with a highly volatile pricing system, access to accurate pricing information should be a nationwide priority.
Across the two reports, it remained clear that most prices in healthcare were a mystery to consumers, employers, and patients. When prices for identical procedures can vary by up to 700%, providing easy and readily access to meaningful pricing information remains critical. Many states only report the charges of treatments and procedures, which rarely reflect the final cost to the consumer. Furthermore, most pricing information is available only on request.
Both the CPR and HCI3 hope these findings prompt state officials to introduce new legislation and regulation that will encourage the reporting of accurate statewide pricing information, including the mandating of a website or web portal to access such data.
It is only until improved efforts are put in place that we can continue along the lines towards a stable and effective healthcare landscape.
For payers and insurers seeking more information on how price transparency can affect their cost-containment efforts, subscribe to our monthly #HealthInsights Newsletter here or feel free to contact PayerFusion Holdings, L.L.C..